Individual
SCOTT D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LCAC
Contact information
Practice address
5486 W US HIGHWAY 40, GREENFIELD, IN 46140-8803
(317) 947-6400
Mailing address
5486 W US HIGHWAY 40, GREENFIELD, IN 46140-8803
(317) 947-6400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
34001913A
IN
1041C0700X
Clinical Social Worker
87000719A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34001913A
MEDICAL LICENSE
IN
01
—
87000719A
MEDICAL LICENSE
IN
Enumeration date
07/31/2020
Last updated
07/31/2020
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